This decision aid is for women who have tried hormone therapy and have had laparoscopic surgery to remove tissue but still have severe symptoms. Other women decide to use hormone therapy before having surgery.
The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new lining grows, getting ready for a possible pregnancy. If you don't become pregnant during that cycle, the lining sheds. This is your menstrual period.
Endometriosis (say "en-doh-mee-tree-OH-sus") is the growth of this tissue outside of the uterus, usually on the ovaries or the fallopian tubes. It also may grow on the outside surface of the uterus, the bowels, or other organs in the belly.
These growths are called "implants." They grow, bleed, and break down with each menstrual cycle, just like the lining of the uterus does. This can cause pain and can make it hard to get pregnant.
In some cases, scar tissue forms around implants. This also can cause pain and trouble getting pregnant.
The female hormone estrogen makes the implants grow. Because the ovaries make most of your body's estrogen, taking out the ovaries can relieve your symptoms.
While some women never have symptoms, others have severe pain that can make it hard to enjoy daily activities. In some cases, the problem can affect how well your bowels, bladder, or other organs work.
Pain from implants may be mild for a few days before your menstrual period. It may get better during your period. But if an implant grows in a sensitive area such as the rectum, it can cause constant pain or pain during sex, exercise, or bowel movements.
Symptoms often get better during pregnancy and usually go away after menopause.
This surgery works very well to relieve pain from endometriosis. But pain does return for up to 15 out of 100 women who have surgery.1 This means that in 85 out of 100 women who have surgery, the pain doesn't come back.
Taking out the uterus and ovaries is usually the last choice in treatment. This is because:
You can take low-dose estrogen after surgery to protect your bones and prevent symptoms of menopause. But this increases the chance that implants could come back.1
This surgery has different types of risks.
Most women don't have problems from surgery. But problems can include:
Without estrogen, you can have severe symptoms of menopause, such as hot flashes, vaginal dryness, moodiness, and depression. Your bones also begin to thin. This increases your risk of osteoporosis in later life. Taking estrogen can prevent these problems.
If you don't want to take estrogen, you can take another type of medicine to make your bones stronger.
Estrogen therapy (ET) may increase the risk of health problems in a small number of women. A woman's increase in risk depends on her age, her personal risk, and when she starts ET. Some of the problems include:2
Your doctor might suggest surgery if:
|Have surgery to remove your uterus and ovaries||Don't have this surgery|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I have had pain before and during my period for years. I tried nonprescription and prescription medicines to control the pain. Nothing was working. Because my pain was so bad, my doctor suggested that I consider a hysterectomy. I didn't like the thought of surgery but had to do something about the pain. Since I'd already had two children, I had the surgery. It has been 6 months now, and I am glad I had the surgery."
— Barbara, age 35
"Endometriosis made me miserable for a week to 10 days every month. Since my husband and I have three children and did not want any more, I decided it was time to take action to get rid of the pain. I decided that ablation made the most sense, because I wanted to keep my uterus and ovaries. My doctor talked with me about the discomfort and risks of having the wall of the uterus treated with a laser. Frankly, it didn't take more than a week to recover, since the incisions were so small. But you know, after a year or so, the pain started coming back. I'm going to have to rethink my options now. Even though my sister has had long-lasting relief from ablation, it's not for me."
— Lucia, age 42
"My periods were really painful about 5 years ago. I went to my doctor, and he asked a lot of questions about my periods and did an exam and some tests. When all the tests came back normal, he said endometriosis might be the cause of my pain. He suggested a hysterectomy but did say that endometriosis can grow back in other places. I still wanted to have a child, so I said no hysterectomy. Fortunately, I did get pregnant, and ever since having my baby my periods have been so much better!"
— Connie, age 35
"My doctor told me endometriosis might be causing my painful periods. I'd never even heard of it before. She told me all about endometriosis and the treatments I could try. She suggested I try taking birth control pills and using ibuprofen before and during my period. It took a couple of months of using this system, but now I hardly have any pain. I am glad I didn't have surgery."
— Harriet, age 39
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery to remove my uterus and ovaries
Reasons not to have the surgery
I tried hormones and had laparoscopic surgery, and my symptoms are still bad.
Medicine is controlling my symptoms.
My quality of life is suffering because of my symptoms.
My symptoms aren't hurting my quality of life.
I'm willing to accept the risks and side effects of surgery.
I'm not willing to accept the risks and side effects of surgery.
I don't plan to get pregnant.
I want to be able to get pregnant.
I'm not close to menopause, so I don't want to wait for the symptoms to go away.
I'm close to menopause, so I prefer to wait for the symptoms to go away.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having the surgery
NOT having the surgery
1. I'm close to menopause, so I could take medicine and wait for my symptoms to go away rather than have surgery.
2. If I have my ovaries and uterus taken out, endometriosis will never give me pain again.
3. I can take estrogen after surgery to make my bones stronger and to keep from having hot flashes and other menopause symptoms.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|